Early Warning Scores for Identification of Patients at Risk of Clinical Deterioration in the Emergency Department: A Narrative Literature Review

Introduction: Emergency department (ED) overcrowding may delay recognition and treatment of patients at risk of clinical deterioration. In this context, early warning scores (EWSs) may support the early identification of high-risk patients and help prioritize timely assessment and intervention. Aim: This narrative literature review aimed to identify the most effective EWSs for detecting clinical deterioration in ED patients and to determine which best predicts short-term mortality. Methods: The search was conducted using the Medline, Web of Science, Scopus, and Cochrane databases between April and June 2024. Results: Multiple EWSs are available for use in the ED, each with distinct characteristics and different levels of prognostic performance. Discussion: All identified EWSs were analyzed and compared with one another, including the evaluation of their sensitivity and specificity values. This highlighted the most and least effective scores for rapidly identifying clinical deterioration and mortality risk in patients admitted to the ED. Conclusions: NEWS and NEWS2 emerged as the most reliable scores for identifying clinical deterioration. Lactate-enhanced tools such as NEWS+L and NEWS2-L appear promising, but are still supported by limited evidence.